Sojan Joseph
MP for Ashford · Labour · United Kingdom
“I agree with the hon. Member that people with power, especially those with political platforms, have used it to spread misinformation about vaccination. Some medical professionals working in our hospitals and the NHS—doctors and nurses—are also against vaccines. Can the hon. Member explain how we can tackle that issue?”
“This morning, I visited the Churchill school in Hawkinge and had a good interaction with the young children. Most of their questions were about protecting nature, and they repeatedly asked how we can support them to plant more trees.”
“As the chair of the APPG on adult social care, I pay tribute to unpaid carers for the enormous contribution they make to their families, their communities and wider society. I often have meetings with them, and as part of my job before I became an MP—I worked in the NHS—I had a lot of contact with carers.”
“I would appreciate it if the Minister would respond to that point, and if the Government would consider something to support carers, while not putting any more administrative burden on the NHS, where we are focusing on providing more support on the frontline.”
“It is good to see you in the Chair, Ms Lewell. I strongly believe that public health is very important to our health system because it focuses on prevention, so that people do not end up in A&E or in hospital beds. Unfortunately, over the last 10 or 15 years we have seen the opposite.”
“I worked as a nurse on the frontline in mental health services, and what we saw was money being diverted to create more senior leadership, more groups, more meetings and more management, while we were missing the people who actually did the work on the frontline.”
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“No other cases have been evidenced, so the rate of that is incredibly low. The voluntary assisted dying team in Queensland, on the same day that they became aware of that case, put in steps to ensure that it would not happen again, which I believe included the required return of the medication. We also have to balance the autonomy of having the medication available to patients at 2 in the morning, when they have an exacerbation of their pain and say that enough is enough, instead of waiting for business hours when the doctors are available to come and sit with them. It is a very delicate balance and there will always be that risk. I think the balance is struck well and the safety can be upheld by still providing the patients access to their own medication.”
“Q Are you aware of any reported incidents of the misuse of medication that has been administered? As you explained earlier, patients can take the medication to their home. Dr McLaren: We were made aware of one situation in Queensland last year. The eligible patient was given the medication, but they ended up in hospital and died from their disease. Their husband then went home, took the voluntary assisted dying medication and died. That was obviously a tragedy and no one wants that to occur, so I do not want to be flippant in talking about it, and I hope my comments are taken in the way they are intended. We know that spousal suicides occur when people die, and we have had one case across Australia compared with thousands of successful cases of voluntary assisted dying conduct.”
“They have to have access to whatever the state and the medical profession are able to provide—again, obviously, depending on what Parliament decides on this particular Bill.”
“But that should be good medical practice, in my view, under all circumstances. This Bill takes it to a high level of need because of the seriousness of the decisions being taken, but that is part of medical practice. Duncan will have discussed with senior nurses, when he when he was operating clinically, “Should we actually get an opinion from a mental health colleague”—either a community psychiatric nurse, if it is that kind of question, a psychiatrist or others—“to make that assessment?” That is really the question, but I certainly would not want to be in a situation where the fact that someone with a terminal diagnosis will have some degree of low mood in itself just rules them out from any kind of medical intervention—this, or any other. That should not be the case.”
“Q Sir Chris Whitty, you said that not all mental capacity assessments are safe. Do you think that hopelessness and low mood can affect someone’s capacity and that a sudden diagnosis of terminal illness can lead to some of those states—depression, low mood and hopelessness? Do you think that all doctors are capable of identifying those states? Professor Whitty: I would hope that most doctors are capable of identifying that someone has some degree—or a large degree—of mental health distress, or mental health illness, if you wish. What not all doctors will feel comfortable doing is actually deciding whether that is sufficient to interfere with someone’s ability to make a decision with full capacity. That is where help from colleagues from psychiatry, and mental health more widely, is going to be useful.”
“People working in end of life, or cancer nurses, for example, often have psychological support to help them deal with some very difficult conversations with patients. We would need to look at that and make sure that sufficient support was in place for anybody working in these situations. We would also need to be mindful about the wider workforce, given the issues from such a debate as this and how the decisions to signpost people on to services might create—for some people—moral injury. We do need to think about the support in place for those people.”
“Q My next question is for Duncan. Nurses who work in stressful environments, such as people working in mental health wards, are expected to get clinical supervision. Do you think that the nurses who are going to work in these areas—if this Bill passes—would require that specialist clinical supervision? And do you think the NHS will have the capacity to provide clinical supervision for the nurses working in those areas? Duncan Burton: I think you are absolutely right—anybody working in stressful environments. If the Bill is passed, we will need to make sure that we have sufficient psychological support for nurses and doctors working in these services, as we do now for many of our nurses and other professionals working in these kinds of situations.”
“In the guidance we talk about, for example, issues with taking a second opinion where there is a greater degree of uncertainty, and the importance of doctors keeping up with the latest clinical knowledge on the efficacy of different treatment courses to come to that determination. We would agree that there is inevitably a degree of uncertainty in the central ground that the chief medical officer was talking about.”
“Q What is your view on the accuracy of the prognoses that we make in this country? If somebody is told that they may live for three years instead of six months, it will make a difference to their decision making. Does the GMC or the BMA have any data or studies on the accuracy of prognosis? Mark Swindells: We do not hold data. I have seen the coverage of the Bill and the uncertainty. I think we would agree with a lot of what the chief medical officer said to you about the stepped decision that a doctor will make, depending on the importance of the situation. We try to capture that in our end-of-life care guidance. We also agree with the point about a doctor giving a central estimate.”
“Of course, in the exploring of assisted dying legislation in Scotland, the second clinical decision maker is a nurse—so it a doctor and a nurse, whereas in England and Wales we are looking at two medically qualified practitioners. We absolutely want to make sure that the skills and support is there for nursing staff, and the ability—as I heard our medical colleagues saying—to not be involved in assisted dying absolutely has to be supported. It cannot be an expectation of the role; it has to be something you choose to proactively take part in as a conscious decision. It cannot ever be just an expectation of a nurse. We are absolutely adamant about that. The Bill cannot just support the needs of medical staff—nursing absolutely has to be included within that, both in skills and support.”
“Q When the RCN Scotland director gave evidence to the Scottish Parliament during the discussion of the Assisted Dying for Terminally Ill Adults (Scotland) Bill, he expressed the RCN’s concern that there were not sufficient safeguards in place to protect nurses and nursing practice around assisted dying in Scotland. Are you satisfied that the Bill we have before us in England and Wales addresses those concerns, or would you like to see amendments to ensure that the mental health and wellbeing of nurses involved in the process are protected, should the Bill become law? Professor Ranger: Yes, we would want to see more support and protection for nurses.”
“The more people we have who are able to bring their different perspectives—the social work perspective on the person’s social circumstances or the medical perspective on their medical condition—the better, so that we have as many eyes on the person and insights into the person as possible. It is about trying to make sure that the decision goes back to whether we are really satisfied that the criteria set out at the beginning of the Bill are met. I personally think we should have MDTs, for instance, as you would have in a Mental Health Act detention, so that we have more than one pair of eyes on it from more than one discipline.”
“Q Alex, thanks for the written evidence and your experience in capacity assessment. We heard from the previous panel, especially from the practising Dr Clarke, how complex it is. She was explaining how she does not think everyone has enough training in capacity assessment, and it is so complex in NHS healthcare areas. You made an observation about multidisciplinary involvement, rather than just two doctors. Do you think having more than two people involved in the decision making can strengthen the Bill? Alex Ruck Keene: I think for many reasons it can. On the pure capacity side, this is, at one level, an existential question. This is not a healthcare decision but an existential decision.”
“I want to talk about amendment (b). The right hon. Member for North West Hampshire said that all members of the Royal College of Psychiatrists are already members of the General Medical Council. But not everyone on the General Medical Council is doing the same job. Psychiatrists are experts whose day-to-day job is to manage people’s mental state, and deal with people with suicidal thoughts and depression. They are the experts. I do not think that all members of the Royal College of Psychiatrists are for or against the Bill, so it would be reasonable to listen to those people who are experts in assessing people’s mental state and whether they are having suicidal thoughts—that is part of their job. I strongly support that part of the provision.”
“My local hospital was not selected for the new hospital programme. While I am happy for colleagues who have received some certainty today on when work on their local hospital will start, does the Secretary of State recognise that there are hospitals the length and breadth of this country that are falling apart, and that staff and patients deserve better? Will he commit to considering a wider estate plan for the rest of the NHS estate, especially in east Kent?”
“Q5. I welcome the efforts this Labour Government have made to reset our relationship with the European Union and to seek to remove unnecessary trade barriers. The trading links between the UK and mainland Europe are of particular importance to my constituency, so will the Prime Minister support my efforts, and those of other Kent colleagues, to restore an international train service to Ashford International station to help economic growth in my constituency, Kent and the wider south-east?”
“As co-chair of the all-party parliamentary group on adult social care, I welcome the fact that this Government recognise that without addressing the social care crisis, more and more people will be left without the care they need and further pressure will fall on the NHS. I am also pleased that the Government have announced an immediate £86 million boost to the disabled facilities grant for this financial year. That is in addition to the £86 million that was announced at the Budget. Together, this funding means that thousands more people will be able to make the improvements they need to their homes so they can live more independently.”
“We need to see more focus on and resources for community-based services to help reduce the pressure on overburdened hospitals, as well as changing the system so that people are treated closer to where they live. As a former mental health nurse, I believe this must also include more timely interventions to treat those in need of mental health support. Currently, not only do too many people end up being treated in hospital, but once patients are there, the absence of enough suitable community-based facilities means it is difficult to discharge them. This leads to further blockages and backlogs in the system.”
“For example, at the William Harvey hospital in Ashford, an average of 84 patients per day were medically able to be discharged in November 2023 but had nowhere to be medically discharged to; in November 2024, the figure was down to an average of 58 patients per day. In the hospitals in east Kent in November 2023, just over 2,000 patients were treated in corridors for more than 30 minutes; in the same month last year, the figure had fallen to just over 1,600 patients. Although the figures are going in the right direction, they are still far too high, and no one working in our NHS would claim otherwise. The staff in the health service will keep doing their best to clear the backlogs, but it will not happen until we see less of an emphasis on patients being treated in our hospitals.”
“In its analysis, the IPPR described long waits for healthcare as the “new normal” for many NHS patients. I welcome the measures that my right hon. Friend the Health and Social Care Secretary and his team of Ministers have already introduced to address this issue. I also welcome the measures that the Prime Minister announced this morning. Thanks to this Labour Government, the NHS in England will receive a record £25 billion investment, which will support the Government in meeting their target of 40,000 extra elective appointments a week. I pay tribute to the dedication of my former colleagues across the NHS, who are working hard to treat patients as quickly as possible and cut waiting times. There is evidence of that happening in my area of east Kent.”
“Addressing backlogs in the NHS, together with changing the current hospital-centric system, will be of central importance in ensuring the long-term sustainability of our health system. Under the Conservatives and the coalition Government, we had more than a decade of under-investment, coupled with a disastrous top-down reorganisation, which caused the high level of backlogs that we currently see across the NHS. While working in the NHS throughout that period, I saw at first hand the dire impact that the reorganisation had on our health service, and how it led to waiting lists at a record high and patient satisfaction at a record low. That was underlined by the recent analysis from the Institute for Public Policy Research, which shows that 25 times more people waited in A&E departments last summer than in the same period in 2009.”
“My neighbouring constituency of Ashford has a big solar farm planned for it. I have recently listened to experts who have highlighted the risk of fire and toxic fumes from large batteries. Some of these farms are planned for rural areas that fire engines may not be able to access. These are genuine concerns. Does the hon. Lady agree that local concerns need to be addressed before planning permission is approved?”
“I worked as a mental health nurse in the NHS for many years and saw many people struggle with their mental health due to traumatic experiences, including family bereavements that happened many years ago, and they were never able to deal with it. Does the hon. Member agree that not addressing traumatic episodes at a younger age can lead to long-term damage to people’s mental health later in life?”
“Given those factors, we must rethink our retention strategy as a whole. Keeping in the United Kingdom skilled workers, especially those who have been the subject of large Government investment, is a vital step towards keeping our NHS alive and making it fit for the future. Therefore, granting healthcare workers indefinite leave to remain after two years rather than five is a necessary measure to solve the retention crisis identified by Lord Darzi in his recent independent report into our NHS. By making a special case for healthcare workers and allowing them to make this country their permanent home after two years, we would show the importance of their roles in the NHS and our gratitude, as a nation, for their decision to come to the UK to train, learn and work in our healthcare sector.”
“The cost of recruiting and training an overseas nurse is anywhere between £50,000 and £70,000, while for a doctor it can be roughly £250,000—only for them to be tempted away by other countries with more attractive recruitment and retention policies, such as Australia and Canada. As the cost of living crisis has worsened over the past decade and a half across the country, especially in the south-east, where my Ashford constituency sits, stagnating wages and rising costs have not been a good incentive to keep staff in the NHS workforce. This issue is also impacting patient care. Losing experienced staff is a big loss for the NHS. It takes 12 to 18 months for managers and matrons to train a newly joined staff member, so losing them in two to three years’ time is a big loss for the hospitals.”
“I would make the point that since I came to the UK in 2001, the rules have changed and people who have the same aspirations as I did now risk finding themselves excluded. As we all know, the NHS is reliant on overseas workers. In the NHS workforce survey in June of this year, just under 30% of NHS staff in England reported having a non-British nationality. However, without proper incentives to both recruit and retain those workers, the employment deficit is likely to worsen. For example, in the years to June 2022 and June 2023, more nurses from the European Union and the European economic area left the NHS than joined. The picture is similar for healthcare workers from the rest of the world. In the year to June 2022, 4,702 healthcare workers left the UK, and for 2023 it was 6,610. In the year to June 2024, 7,957 workers left the UK.”
“It is a pleasure to see you in the Chair, Sir Edward. I congratulate my hon. Friend and constituency neighbour the Member for Folkestone and Hythe (Tony Vaughan) on his excellent speech introducing this important debate. Members will know that before being elected to represent my home constituency of Ashford in July, I had spent the previous 22 years working in the national health service. As someone who also made the journey to work in the NHS from a foreign country, I will draw on my knowledge and set out in my short contribution why I support the e-petition and would back reducing from five years to two the time a foreign healthcare worker has to wait before qualifying for indefinite leave to remain.”
“The Leader of the Opposition took time at her party’s conference to say that “a little bit of adversity” in life is good for people’s mental health. That approach clearly did not work for the 2 million people stuck on mental health waiting lists because of the last Tory Government. Will the Prime Minister commit to tackling mental health waiting lists in the NHS?”
“It is important that victims of crime have the swift access to justice that they deserve, so I welcome the extra funding from this Government that will lead to more than 106,000 sitting days in Crown courts this financial year. That includes nearly 3,000 in the Crown courts in Kent. Does the Minister agree that dealing with the court backlog left by the Conservatives is essential to make sure that offenders are quickly brought to justice and faith is restored in the criminal justice system?”
“At the time, it was reported that at least £210 million would have to be spent over the next five years on essential improvements to hospitals in east Kent just to maintain safe services. As we look to deliver an NHS fit for the future, I say to my right hon. Friend the Minister that money spent patching up ageing buildings would be better invested in improving standards for patients in east Kent. I therefore hope that the proposals and promises from the previous Government can be reconsidered. The choice made by the Chancellor to invest in the country’s future and fix the broken public services left by the Tories is a clear rejection of that party’s failed policies, so I welcome the Budget.”
“I was pleased by the recent confirmation from the Health and Social Care Secretary that there will be more details on the new hospital programme in the new year. I would like to make a strong case for the William Harvey and the other hospitals in the East Kent hospitals university NHS foundation trust. In 2019, when Boris Johnson was Prime Minister, he promised that east Kent would get a new hospital. Proposals were drawn up for either a new hospital in Canterbury or upgraded facilities at the William Harvey hospital and the Queen Elizabeth the Queen Mother hospital in Margate. Despite what Boris Johnson said, last year the Conservative Government broke that promise.”
“On that point, I was pleased to see that there will be more than £2 billion spent on healthcare technology and digital investment to run essential services and drive improvements in NHS productivity. I believe that will have widespread support from my former colleagues working in the NHS. If we ensure that all trusts have access to electronic patient records, that will not only be much better for the patient, but will increase staff productivity, freeing up more time to treat patients. When I paid a visit to the William Harvey hospital in the Ashford constituency in August, 19 patients were being treated in corridors. That is deeply concerning, as during the summer there is supposedly less demand on the A&E department. This money will be well received in hospitals such as the William Harvey.”
“I welcome the opportunity to speak in this debate on the first Labour Budget for nearly 15 years. I must disclose that I worked in the NHS for the past 22 years as a mental health nurse. As a result of the Budget, the NHS will receive the largest rise in day-to-day spending outside the pandemic since the last Labour Government. The additional £22.6 billion over two years will play a major role in cutting waiting times from their current unacceptably high levels. We all know that money on its own will not be enough to create an NHS fit for the future, so I agree with my right hon. Friend the Secretary of State for Health and Social Care that it is important that the increased investment outlined in the Budget comes with the necessary reform of the NHS.”
“Small and independent shops are the lifeblood of our high streets, and they make the communities in my Ashford constituency special. Far too many high street businesses have been feeling the squeeze over recent years, which has led to empty units being an all too familiar sight. I welcome the measures announced in yesterday’s Budget, particularly the reform of business rates. Will my hon. Friend update the House on what the Government are doing to empower local communities to acquire empty units?”
“T5. I recently met local businesses in my constituency to discuss what can be done to attract more people to visit our high streets. Will the Minister set out what action the Government are taking to help regenerate local high streets, and will he meet me to discuss this issue further?”
“Does the hon. Gentleman agree that the decision by the last Conservative Government to freeze local housing allowance for temporary accommodation claimants at 2011 rates is causing increasing pressure on local authorities, such as mine in Ashford?”
“By doing that, the Government will be able to grasp the opportunity to transform the way we approach the issue of mental health, ensure that there is true parity of esteem and provide real, meaningful change in the mental health system.”
“With that in mind, the priority that this Government have already given to cutting pollution and building high-quality houses is welcome. I also welcome the proposed pre-watershed junk food ban and the steps that Ministers are taking to create a smokefree society. Going forward, I want to see greater cross-Government working to address the social determinants of our mental health. In the coming months, the Government are set to publish their 10-year plan for the NHS. As my hon. Friend the Minister and his colleagues work on that, I hope that they will consult with campaigners and organisations working in mental health, as well as representatives of the workforce.”
“As the Mental Health Foundation has said, there is clear evidence that place and the circumstances in which people are born, grow, study, live and work have a powerful influence on their mental health. Therefore, there must be a fundamental reform of the way in which we deal with mental health. We should be addressing the complexity of interactions and relationships, and how they affect individuals, families and communities. Rather than starting from the point of treating mental health, we should put the emphasis on creating a society that prevents mental ill health in the first place. Beginning with central Government, I want to see a co-ordinated approach to developing effective policies to protect people’s mental health.”
“Helping them back to work will also help to grow our economy. Lord Darzi’s report identified that, since the pandemic, the number of people who are economically inactive has increased by around 800,000, with people with mental health conditions accounting for most of the increase. I welcome the Government’s new initiative to work across Departments and create links between long-term unemployment and health. I also hope that they will look to reform the benefit system, ending the blame culture identified by the Secretary of State, so that we can treat people with mental health problems with dignity. I welcome the greater emphasis that Ministers have said will be put on prevention of illness, and I hope that my hon. Friend the Minister will be able to reassure me that the same emphasis will also apply to mental health.”
“Our manifesto commitment to introduce a specialist mental health professional in every school will be important in helping to identify mental health conditions early on so that they can be prevented from developing into more serious conditions in later life. Will that include access to counselling? Research from the British Association for Counselling and Psychotherapy indicates that children whose mental health difficulties are initially too complex for lower intensity interventions but not complex enough to be referred to higher intensity interventions, such as child and adolescent mental health services, can easily miss out on the mental health support they need. They could instead be helped by forms of provision such as counselling. All the evidence shows that being active helps people’s mental health.”
“Friend the Minister whether greater priority will now be given to community-based support for mental health services. I hope he will agree that the easier it is for people to access mental health services locally, whether in a traditional health setting or through more informal drop-in services, the quicker they will be able to get the treatment they need. Will my hon. Friend update us on the Government’s plans for Young Futures hubs for children and young people? These open-access drop-in hubs will be an important step in providing community-based mental health support for children and young people. Will he say something about the roll-out of those hubs?”
“Research from the Maternal Mental Health Alliance published last week shows that more than 20% of women will face mental health challenges either during their pregnancy or in the perinatal period. It is clear from the research that many women struggle to access support, particularly those from racialised communities, young mothers and those experiencing domestic abuse or living in poverty. We know that intervening early to ensure that people are kept in good health is not only better for the individual but tends to be far less costly. However, until now, efforts to prevent mental ill health have been severely underfunded and they have not been given the priority they deserve. I hope we will see a marked change in approach under this Government. With that in mind, I ask my hon.”
“We have seen an increase in adults being treated in hospitals for their mental health, and the situation is the same for children and young people. A recent report from the Education Policy Institute shows that the number of young people admitted to hospital increased by one fifth between 2017 and 2023. As the report indicates, that suggests that more young people are reaching a crisis point and are experiencing multiple admissions. The evidence also indicates that a large number of young people are not getting the necessary mental health support. A survey for Young Minds revealed that at least 60% of children considered to have a diagnosable mental health condition had not had contact with the NHS.”
“However, between April and June, the average occupancy rate of the 444 mental health beds in Kent and Medway was 91.7%. Across England, the average occupancy rate was 89.9%. Then there is the issue of discharging patients. When they are clinically ready to leave hospital, there is often nowhere for them to go. That leaves them stuck in hospital, causing blockages in the system. In my own experience, nurses, doctors, managers, matrons and directors spend many working hours looking into moving people out of hospital, when they should be focusing on patient care. I believe that more appropriate housing must be built that is open for people leaving hospital. I urge the Department of Health and Social Care to work across Government to ensure that as the Government’s planning reforms are introduced, that point is taken into consideration.”
“They have helped to reduce the number of people who seek support by going to hospital emergency departments when they experience a mental health crisis. In my constituency, there is not yet a safe haven. That may explain why William Harvey hospital in Ashford has one of the highest rates of individuals presenting with primary mental health needs at an A&E. I welcome plans that are under way for a safe haven at the hospital in the near future. When patients end up in hospital, there are significant difficulties in getting them a bed. This is a challenge in Kent and Medway, but the picture is not dissimilar across the rest of England. The Royal College of Psychiatrists recommends a maximum occupancy rate of 85% of beds for mental health patients.”
“That underlines the importance of a wholesale change so that support can be accessed at an early stage. Too often, people can access support only after they have ended up in crisis. NHS figures show that in July there were just over 40,000 new urgent, very urgent or emergency referrals to crisis care teams. At that point, the treatment that patients receive is not only more intensive for them, but more costly for the NHS. The difficulty of accessing mental health services explains why increased numbers of people who require support end up being admitted to accident and emergency departments. To illustrate that, I will use the example of my own integrated care board in Kent and Medway, which has recently launched several safe havens to provide support for anyone in a mental health crisis.”
“I hope the new Bill will address the fact that someone who is black or living in a deprived area is almost four times as likely to be sectioned under the Act. Will my hon. Friend the Minister tell me when we can expect to see the Government’s legislation introduced in Parliament? As Lord Darzi identified in his report, the lack of capital investment in places where people are sectioned means that a lot of those places are unsuitable, outdated and unsafe. From my own experience, I know that nurses, managers and matrons spend a lot of time trying to get capital works done in an NHS trust. People living with a long-term physical condition are 50% more likely to suffer from mental ill health, while those with Parkinson’s disease are twice as likely to be at risk of suicide.”
“The increase in the prevalence of depression over the last decade is a good example of how our mental health as a nation has got significantly worse. In 2012, the prevalence of depression was 5.8%. By 2022 that had more than doubled to 13.2%. In my own constituency of Ashford the figure was even higher, at 17%. Given the increased prevalence of mental health issues, I was pleased that in the first King’s Speech of this Labour Government we saw mention of legislation to modernise the Mental Health Act 1983. The proposed legislation has been welcomed across the sector. It is an important opportunity to improve care and strengthen safeguards for people who are admitted to mental health hospitals.”
“The NHS’s own data shows that in April this year, 10% of people who had been in contact with mental health services and were waiting for their second contact in adult community mental health services had been waiting for at least 116 weeks. All the evidence indicates that today we have a mental health system that is overstretched and under-resourced. In fact, there has never been so much demand for mental health support, with one in four people experiencing a diagnosable mental illness each year. Figures from the British Medical Association indicate that last year there were a record 5 million referrals to mental health services in England. That is up by 33% on the number of referrals in 2019.”